{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T20:38:05Z","timestamp":1771015085060,"version":"3.50.1"},"reference-count":35,"publisher":"Wiley","issue":"15","license":[{"start":{"date-parts":[[2015,4,15]],"date-time":"2015-04-15T00:00:00Z","timestamp":1429056000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2015,8]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>A watch and wait (WW) strategy is the standard of care for patients with asymptomatic advanced\u2010stage follicular lymphoma. Recent data have demonstrated an improvement in the time to progression with rituximab induction (RI) with or without rituximab maintenance (RM) in comparison with a WW strategy wait in such patients. It remains unclear whether this is a cost\u2010effective strategy.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>A Markov decision analysis model was developed to compare the clinical outcomes, costs, and cost\u2010effectiveness of RI (4 weekly doses) plus RM (12 doses every 2 months), RI (4 weekly doses), and a WW strategy for patients newly diagnosed with low\u2010burden, asymptomatic advanced\u2010stage follicular lymphoma over a lifetime horizon. Baseline probabilities and utilities were derived from a systematic review of published studies, and they were evaluated on a 6\u2010month cycle. A Canadian public health payer's perspective was adopted, and costs were presented in 2012 Canadian dollars.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>RI was the cheapest strategy. It was less costly at $59,953 versus $67,489 for the RM arm and $75,895 for the WW arm. It was also associated with a slightly lower quality\u2010adjusted life expectancy at 6.16 quality\u2010adjusted life years (QALYs) versus 6.28 QALYs for the RM strategy but was superior to WW (5.71 QALYs). In sensitivity analyses of key variables, this effectiveness was sensitive to the probability of first and second progression in the RI arm, and this indicated relatively neutral effectiveness between the 2 rituximab arms.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>RI without maintenance for asymptomatic advanced\u2010stage follicular lymphoma is the preferred strategy: it minimizes costs per patient over a lifetime horizon. <jats:bold><jats:italic>Cancer<\/jats:italic> 2015;121:2637\u20132645<\/jats:bold>. \u00a9 <jats:italic>2015 American Cancer Society<\/jats:italic>.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.29372","type":"journal-article","created":{"date-parts":[[2015,4,15]],"date-time":"2015-04-15T13:32:01Z","timestamp":1429104721000},"page":"2637-2645","source":"Crossref","is-referenced-by-count":24,"title":["Frontline rituximab monotherapy induction versus a watch and wait approach for asymptomatic advanced\u2010stage follicular lymphoma: A cost\u2010effectiveness analysis"],"prefix":"10.1002","volume":"121","author":[{"given":"Anca","family":"Prica","sequence":"first","affiliation":[{"name":"Division of Hematology Department of Medicine Princess Margaret Cancer Centre, University of Toronto  Toronto Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelvin","family":"Chan","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology Department of Medicine Sunnybrook Health Sciences Centre, University of Toronto  Toronto Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Cheung","sequence":"additional","affiliation":[{"name":"Division of Hematology Department of Medicine Sunnybrook Health Sciences Centre, University of Toronto  Toronto Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,4,15]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/PPO.0b013e31826aed4f"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1586\/erp.12.57"},{"key":"e_1_2_7_4_1","first-page":"213","article-title":"Follicular lymphoma: expanding therapeutic options","volume":"19","author":"Ganti AK","year":"2005","journal-title":"Oncology (Williston Park)"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1997.15.3.1110"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)14110-4"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2008-04-153189"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.13.5376"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V97.1.101"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(14)70027-0"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2003.09.542"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61763-2"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)62175-7"},{"key":"e_1_2_7_14_1","first-page":"719","article-title":"The cost of treating relapsed indolent non\u2010Hodgkin's lymphoma in an international setting: retrospective analysis of resource use","volume":"87","author":"Herold M","year":"2002","journal-title":"Haematologica"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mds177"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2141.2000.01965.x"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.12.052"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2010.28.4786"},{"key":"e_1_2_7_19_1","unstructured":"Statistics Canada. 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